Cabinet Secretary
Matt Althoff
South Dakota Medicaid: Eligibility Changes Coming Soon
Stay Informed!
On July 4, 2025, President Trump signed the Federal Reconciliation Bill (H.R.1) into law. This new law brings changes to Medicaid. All states must implement the changes in the law, which are summarized below.
Community Engagement or “Work Requirements”
Effective January 1, 2027, some adults enrolled in Medicaid Expansion must show they are completing community engagement activities to keep their coverage.
Community engagement means completing at least 80 hours each month of one or more of the following activities:
- Working
- Job training
- Community or volunteer service
- Enrolling in or attending school at least half-time
- A combination of these activities
Who Must Meet the Requirement?
Adults ages 19 through 64 who are eligible for Medicaid Expansion must meet the community engagement requirement unless they are excluded.
New Applicants
If you are applying for Medicaid Expansion on or after January 1, 2027, and you are not excluded, you must show that you completed the required 80 hours during the month before you apply.
Current Medicaid Expansion Recipients
If you are already enrolled in Medicaid Expansion, the community engagement requirement will apply at your first regularly scheduled renewal in 2027. If you are not excluded, you must show that you completed the required 80 hours in at least one month since your last renewal.
Who Is Excluded?
You do not have to meet the community engagement requirement if you:
- Are under age 26, were in foster care at age 18, and enrolled in Medicaid at that time.
- Are American Indian or Alaska Native, including people who are eligible for Indian Health Service.
- Are the caregiver of a child age 13 or younger or of a person with a disability of any age (you may still qualify even if you do not live with them or not related to them).
- Are a veteran with a total disability rating.
- Are medically frail or have a disability, serious medical condition, or other special medical need that limits your ability to meet the requirement.
- Are already required to meet SNAP or TANF work requirements.
- Are receiving treatment or rehabilitation for drug or alcohol addiction.
- Are currently incarcerated or were recently released from a public institution.
- Are pregnant or eligible for postpartum Medicaid coverage.
How Will DSS Verify the Requirement?
The Department of Social Services (DSS) will use available data sources to determine whether you:
- Are excluded from the requirement, or
- Have already met the required community engagement hours.
If DSS needs additional information, it will request it:
- At the time of application for people applying on or after January 1, 2027, or
- At your first regularly scheduled renewal in 2027.
How Can I Check My Status?
Beginning January 1, 2027, Medicaid Expansion recipients can find information about whether they are excluded or have met the community engagement requirement by:
- Reviewing notices from DSS.
- Logging into the BEES Customer Portal.
If you have questions, contact your local DSS office for assistance.
More Frequent Renewals
Currently: Eligibility renewals are scheduled every 12 months.
Effective January 1, 2027: Eligibility renewals will be:
- Every 6 months for Medicaid Expansion enrollees.
- Every 12 months for adults and children enrolled in any other coverage group.
Retroactive Coverage or "Backdating"
Currently: Medicaid coverage to be backdated up to 3 months prior to application.
Effective January 1, 2027: Retroactive coverage will be limited to:
- 1 month for adults eligible for Medicaid Expansion.
- 2 months for adults and children eligible for any other coverage group.
Impacted Individuals: All Medicaid and CHIP applicants
Cost Sharing Requirements for Certain Services
Currently: There are no cost sharing requirements.*
Effective October 1, 2028: Medicaid Expansion enrollees with income above 100% of the Federal Poverty Level will have cost shares for non-exempt services. This will not be more than 5% of a family’s income.
Exempt services include primary care, prenatal care, pediatric care, necessary emergency room care, Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), mental health, and substance use disorder.
Impacted Individuals: Medicaid Expansion enrollees. American Indians and Alaska Natives are exempt, including people who are eligible for Indian Health Service.
*Cost sharing is not the same as post-eligibility treatment of income (PETI) cost sharing procedures for long-term care or home & community-based waiver services.
Upcoming Medicaid Town Hall Webinars
Join us for webinars about upcoming Medicaid eligibility changes. These sessions are for customers, providers, and community members. We will offer two opportunities to attend. If you cannot join either webinar, the slides and a recording will be posted on this page after the sessions are finished.
| Meeting Dates and Times | Microsoft Teams Information |
|---|---|
| Date: Wednesday August 19, 2026 Time: 10 – 11 Central Time |
Meeting ID: 253 244 533 789 94 Passcode: T33Ts3pV |
| Date: Friday August 28, 2026 Time: 11 – 12 Central Time |
Meeting ID:238 893 402 686 Passcode: Nk6bF6BP |
What Medicaid Enrollees Can Do Now
- Make sure your preferred mailing address and phone number are up to date with DSS.
- Sign up to receive email and/or text alert notifications when we send you mail in the SD BEES Customer Portal.
- Contact your local office if you have questions.
- Join the Recipient Listserv and visit Medicaid Recipient Communication to stay up to date.
- Follow DSS on Facebook, and Instagram
- Visit Medicaid.gov to learn more about upcoming changes.
- Read the Community Engagement Fact Sheet being mailed to all Medicaid Expansion recipients in August 2026.
What Providers and Stakeholders Can Do Now
- Encourage Medicaid enrollees to keep their preferred mailing address and phone numbers up to date with DSS.
- Sign up for the Division of Medical Services’ Listserv and visit Medicaid Provider Communication
- Sign up for the Tribal Consultation Listserv and visit Medicaid Tribal Consultation .
- Follow DSS on Facebook and Instagram
- Visit Medicaid.gov to learn more about upcoming changes.
- Read the Community Engagement Fact Sheet being mailed to all Medicaid Expansion recipients in August 2026.
Implementing HR1: A Communications & Social Media Toolkit
The following outreach and marketing resources are available for partners to use to help inform South Dakotan’s enrolled in Medicaid about the important steps they need to take to prepare for upcoming changes.
Frequently Asked Questions
What are the new Community Engagement/Work requirements and who is affected?
Effective January 1, 2027, some adults enrolled in Medicaid Expansion must show they are completing community engagement activities to keep their coverage.
Community engagement means completing at least 80 hours each month of one or more of the following activities:
- Working
- Job training
- Community or volunteer service
- Enrolling in or attending school at least half-time
- A combination of these activities
Who Must Meet the Requirement?
Adults ages 19 through 64 who are eligible for Medicaid Expansion must meet the community engagement requirement unless they are excluded.
New Applicants
If you are applying for Medicaid Expansion on or after January 1, 2027, and you are not excluded, you must show that you completed the required 80 hours during the month before you apply.
Current Medicaid Expansion Recipients
If you are already enrolled in Medicaid Expansion, the community engagement requirement will apply at your first regularly scheduled renewal in 2027. If you are not excluded, you must show that you completed the required 80 hours in at least one month since your last renewal.
Who Is Excluded?
You do not have to meet the community engagement requirement if you:
- Are under age 26, were in foster care at age 18, and enrolled in Medicaid at that time.
- Are American Indian or Alaska Native, including people who are eligible for Indian Health Service.
- Are the caregiver of a child age 13 or younger or of a person with a disability of any age (you may still qualify even if you do not live with them or not related to them).
- Are a veteran with a total disability rating.
- Are medically frail or have a disability, serious medical condition, or other special medical need that limits your ability to meet the requirement.
- Are already required to meet SNAP or TANF work requirements.
- Are receiving treatment or rehabilitation for drug or alcohol addiction.
- Are currently incarcerated or were recently released from a public institution.
- Are pregnant or eligible for postpartum Medicaid coverage.
How Will DSS Verify the Requirement?
The Department of Social Services (DSS) will use available data sources to determine whether you:
- Are excluded from the requirement, or
- Have already met the required community engagement hours.
If DSS needs additional information, it will request it:
- At the time of application for people applying on or after January 1, 2027, or
- At your first regularly scheduled renewal in 2027.
How Can I Check My Status?
Beginning January 1, 2027, Medicaid Expansion recipients can find information about whether they are excluded or have met the community engagement requirement by:
- Reviewing notices from DSS.
- Logging into the BEES Customer Portal.
If you have questions, contact your local DSS office for assistance.
Will aged (65+), blind, or disabled individuals be required to work?
No. These individuals are exempt from community engagement requirements.
What are the changes for noncitizens?
Effective October 1, 2026, some noncitizens will no longer qualify for Medicaid, including:
- Asylees
- Refugees
- Noncitizens granted parole for at least one year
- Certain victims of abuse or trafficking
Some noncitizens will still qualify for Medicaid (as long as they meet other eligibility criteria) including:
- Most Lawful Permanent Residents (“green card holders”)
- Cuban and Haitian Entrants (CHEs)
- Lawfully residing Compact of Free Association (COFA) migrants
- Unborn children of ineligible noncitizens
How will Medicaid enrollees know if the changes impact them?
DSS will begin notifying Medicaid Expansion enrollees who are impacted by community engagement requirements in September 2026. Impacted enrollees will be sent mail ensuring they understand community engagement requirements, exemptions, and exclusions, including ways they can verify their community engagement.
DSS always notifies enrollees of changes before they occur.
Stay informed!
- Sign up for the SD BEES Customer Portal to apply or renew your coverage, upload documents, sign up for text and/or email notifications, access eligibility-related documents, and learn more about your coverage.
- Make sure your preferred mailing address and phone number are up to date with DSS.
- Contact your local office if you have questions.
- Join the Recipient Listserv and visit Medicaid Recipient Communication to stay up to date.
- Follow DSS on Facebook and Instagram
Who has to renew their coverage every 6 months?
Only individuals enrolled in Medicaid Expansion (aged 19 through 64, not eligible for or enrolled in Medicare, with income up to 138% of the Federal Poverty Level) will be required to undergo the renewal process every 6 months. Individuals who are Alaska Native or American Indian are exempt.
DSS uses information available on file and through electronic verifications to find enrollees eligible again at renewal. If additional information is needed to determine ongoing eligibility, enrollees must complete a renewal and if necessary, provide requested verifications.
What if someone no longer qualifies for Medicaid?
For the majority of individuals, coverage will not change. However, some adults who no longer meet citizenship requirements or community engagement requirements may not qualify for Medicaid.
Individuals who do not qualify for Medicaid may still be able to get health insurance, and help paying for it, through the Health Insurance Marketplace. For more information on the Health Insurance Marketplace, please call 800.318.2596 (TTY: 855.889.4325) or visit www.Healthcare.gov.
Will everyone have new copayments?
HR1 requires states to implement copayments for some Medicaid Expansion enrollees with incomes above 100% of the Federal Poverty Level, starting in October 2028.
There are limits on how much a state can require as a copayment. For example, copayments cannot be more than $35 or a certain percentage of an individual’s income. Copayments will only be required on certain services.
Individuals who are Alaska Native or American Indian are exempt from copayments.
General Information
- DSS Statistical Information
- Medicaid Changes Coming Soon
- Frequently Asked Questions
- HomeAgainSD
- Join our Listserv
- Medicaid Advisory Committee
- Medicaid Beneficiary Advisory Council
- Medicaid Eligibility
- Medicaid State Plan
- Phone List
- Reports
- Tribal Consultation
- 1115 Demonstrations